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Plano,Texas75024 www.safety-kleen.com Y ac:ntuuL uu yUK""u Lj 1ST FOR SERVICE GALL BRANCH MANAGER DOC_EXP. sERY10E WEEK TERRITORY {I�q. CUSTOMER NO. 179-X45- 101 RALPH TORRES 0{1'20/09 09--1 7 2_. 003896490! C - --IPREVIOUS BALANCE CODE BAL OVER U ti•. J , -� .. 0003-2646-64 � � D 6".5. 30 42.x. Y6. 3 ~ ", EGMENT CHAIN , SVG.PSC PROD.P/C T . _ TRACY AUTO c,t�UvP Lc APR 2 2 CDOU"TOV o 3-4-60 NAGLEfs RD 460 NAGLEE RD Liz c0no N .34I 341° M E RAC CA 95304 • TRACY CA 95378 LOCATION TAX EXEMPTION NO. R1 718501 SERVICE DATE JSALE.S REP NO, CUSTOMER P.O.NUMBER CUSTOMER PHONE# TAX CODE DATE EQPTIPROD ORDERED SERVICE TAX C.O.M.S.TAX PRODUCT TAX 1+ L ,� ' 209-820-180 0S-19S -fr�4 AAAI . 08 5 0875 SERVICE( - REMARKS/ SALES TOTAL WASTE SOLVENT/DRUMS SERVICE CHANGE INV. PROMO Msol DEPT PRODUCT 1 11I�!E?e E I3 UNEP PRICE QUAN. CHARGE TAX CHARGE MIN. CLEAN SPENT .ox s1c ooT CC TERM SERVICETERMscxW6) cpDe No. R E L I }A i NC` GNB EKS IN4TIAL M'M!A1 1 C 0?3 87 0. 'U 0 c 0 ❑ 2 ( 090837 0001112 8 1 191. 59 16. 6 203. a 0. Ci .14n 1 s u�30$: i 000508'179 1 .191. 55 9, 16 . 16 208. j5 0. ( 0 L 149 4 1 ❑ 4 CLO92 38 I (J801316.1 1 , ❑ 5 238'7 (°8021 5 8 1 ❑ 6 13 01000 _ i 9, 22 0. 8 1 1. (13 0.o El 7 ❑ 8 A: ❑ io ❑ 11 El 12 ❑ TOTAL SERVICE/PRODUCTS t1° CHECK Opp!) POOR VE DECALS IN PLACE NO MACHINE PROPERLY GROUNDED YES NO i L k f _ y t f 7 APPROPRIATE MACHINE CONDIT ❑ AND LEGIBLE ❑ © z BOXES A CLEANLfNE55 FUSIBLE LINK LOCAL PHONE M STICKER Z AF-HXEO TO MACHINE INSTALLED El LLI USEPA-TRANSPORTER,110 NO,USEPA.TRANSP R�I�T`�L'�� '�rR�,'�, • .. j �}�� _, �, /y T. +'S�'A JL�.��,�'.' LAMtPASSEMBLY ❑ EMERGENCY CLOSING SPENT SOLVENT MEETS ❑ 2 CONDITION ❑ ACCEPTANCE CRITERIA TYROOC,0S09 3�7 �'A,L0003 32 356OF LID UNOBSTRUCT€O A 11.US DOT DESCRIPTION (INCLUDING PROPER SHIPPING NAME;HAZARD CLASS,AND ID. Q,CON AINERs ia. ToraL 14.UNIT SK DOT NUMBER 1 6 3 0 5 CERTIFY THAT MY TOTAL W y,SOOU1}S�E� T� Ys C i ) - T �,5 OL �z ASTE STREeMS ARE WITHIN d'[�J LV"'[T�.�.LLf] HAZARDOUS WASTE,. LIQUID `� - .n-7 A-1'i 0,,-� 7 ""'� GATEGORIESNE OF E'' OWING k, I r l SOLUTION)L�I 1'1 013 qq (f t rJ 0 TO 221)tB NTH AQUEOU1:1 FARTS WASHE I / t� � �. T � Z ACCT �( INITIALS • j,•�, r .0 LBS.TO 2.M WSJMONTH Q ACCT INITIALS W �. I GREATER THAN 2,200 LBSJMOHTH Q 4 �• NAME - - - INITIALS flf`Q DESIGNATED FACILITY NAME AND ADDRESS SAFETY--KLEEN SYSTEMS: 1140. ICERTIFYTHAT NOMATERIAL CHANGE HAS OCCURREDUSAEPA IDNO. L (. 0 'C '4511 dt En'HER IN THE CHARACTERISTICS OF THE WASTE 6 000 88TH S TR E E'•T S:A.0 R AIYIE NT O CA 95828 MATERIALS OR IN THE PROCESS GENERATING THE STATE ID NO. '• : i � — Uy WASTE MATERIALS. CASH ❑ TOTAL RECEIVED APPLY PAYMENT TO: s 11►g1( 7"., I AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND TOTAL CHARGE V; CHECK NUMBER — �.., CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. (FROM ABOVE) >1 ❑TODAY'S 9ERNGElSALEjjjj z PLEASE CHARGE 101 ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE mc PREVIOUS BASANCE A5 FOLLOWS Y INOICATED IN THE PAYMENT RECENEO SECTION,THE INDMOUAL SIGNING THIS WASTE MIN. LDA M §SAGE DOCUMENT IS DULY AUTHORIZED TO SIGN AND BIND CUSTOMER TO ITP TERMS. (FROM ABOVE) LLJ INVOICE# AMOUNTS INVOICE# AMOUNT$ 1.m�«Kro 1h,e"ano—a d mel«Ne Qe y aesa�ea,�a area.�xoc Dna I®belea..na ` ww«CpafO�lO cane ...—Y+e91 tn.yq'r.cb�s.e«.mu7 .nwr� « TOTAL DUE r'Ft IOUS _.---,- _T _.M._ ....._. _' MANIFEST BEG# .i Y f -.. DO NOT WRITE IN THIS AREA BELOW t=DTf I A ✓a 4 i 71 r# r t ti_?,i - E , Prin Cumer Name CREDIT CARD NO, AMEX EXP.DATE ry r r' NCE C[letomer's Authorized Representative. 11 '1 TI eAn •i+me airmI e`nm ripm ICC nru-ruc omicDCC czinr—